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Radioactive colloidal gold has been used in the treatment of certain cases of prostatic carcinoma at the University Hospitals, State University of Iowa, during the past six and one-half years. From March 21, 1951, to June 1, 1957, 384 cases were treated through a retropubic approach, with injection of radioactive material under direct vision; 130 were treated by perineal injection, and 3 received gold by the transrectal route (Table I). Thirty-five patients received perineal injections for palliation. One hundred and thirty-five of these patients were treated over five years ago. Two hundred and ninety-four patients were given a single injection of gold, 184 two injections, and 74 three or more. This paper deals with the experience gleaned from the entire group and the survivals among those patients treated over five years ago. Selection of Cases for Treatment Originally only those patients having biopsy-proved carcinoma of the prostate extending clinically beyond the confines of the capsule but limited to the local area were considered suitable for treatment by radioactive gold. When the disease was confined within the prostatic capsule a total prostatectomy was done, while patients having metastases to bones or viscera were treated by transurethral resection, orchiectomy, and estrogens. Some of the patients had extensive local disease which now would be considered a contraindication for the use of radioactive gold. Early in our experience of selecting patients, very little attention was paid to the age or general condition, the length of time disease had been present, or previous treatment. This was unwise, since prostatic carcinoma is a slow-growing disease, often well controlled for long periods of time by the use of hormones and other palliative measures. The operative procedure necessary for the injection of gold carries a certain incidence of mortality and morbidity and, while this incidence is low, it is sufficient to warrant a more critical selection of cases than has been practiced. The concept that prostatic carcinoma spreads most often through vascular channels, and that it metastasizes to lymph nodes infrequently and late in the disease, has proved erroneous (Table II). Of 384 patients with local disease and without evidence of blood borne metastases, 146 or 38 per cent were found to have positive cancer-bearing nodes at time of surgery. Results reported in previous papers (1–3) show that the life expectancy of these patients is not influenced by the use of radioactive gold. It seems unlikely that technical improvement in the use of radioactive material will increase the salvage in this group of patients. At present, more radical surgical procedures are used for removal of involved lymphatics, while control of the primary lesion is still attempted by radiation. It is too early to evaluate the results obtained from such a combined method.